Ellis Barnett

The radiological diagnosis of osteoporosis: A new approach*

Summary 1. A new procedure is described for the radiological assessment of osteoporosis. 2. This method depends upon the measurement of cortex to shaft ratio in a femur and a metacarpal and the measurement of biconcavity in the spine. 3. Arbitrary normal standards have been established in a control series of 125 adult outpatients. 4. This method has been applied to about 150 patients suspected of metabolic bone disease, and abnormal results were obtained in eighty-seven (seventy-one women and sixteen men)

Ultrasound in the investigation of space-occupying lesions of the urinary tract

In recent years increasing interest has developed in the use of diagnostic ultrasound in the investigation of lesions of the urinary tract. (Damascelli, Lattuada, Musumeci and Severini, 1968; Holmes, Wright, Meyer, Posatony and Howry, 1965; Holmes, 1966; 1967; Ostrum, Goldberg and Isard, 1967; Howry, 1965; Goldberg, Ostrum and Isard, 1968; West, 1967; Leopold, 1970; Schreck and Holmes, 1970). The present paper records our experience with diagnostic ultrasound in the investigation of the urinary tract with particular reference to space-occupying lesions. Initially, a number of patients without urinary tract lesions were scanned to standardize the technique of examination and to establish the ultrasonic appearances of the normal kidney and bladder. Subsequently a study was made of a series of 40 patients with a space-occupying lesion associated with the upper urinary tract, and a further 17 patients with a bladder tumour, 16 of which ultimately proved to be malignant. In addition, with reference to the diff...

THE INCIDENCE OF OSTEOPOROSIS IN PATIENTS WITH FEMORAL NECK FRACTURE

1. Recently described histological and radiographic methods of diagnosing osteoporosis have been applied to patients with transcervical and intertrochanteric fractures of the femur. 2. Both methods indicate a higher incidence of osteoporosis in such patients than in a control series, especially in older women with intertrochanteric fractures. 3. A discrepancy between the results of biopsy and radiographic examination was encountered, the explanation of which is not yet clear.

The use of ultrasound in the diagnosis of pelvic masses

Abstract This paper consists of an analysis of 262 female patients referred for ultrasonic examination with a suspected pelvic mass. An attempt has been made to formulate diagnostic criteria for the various types of pelvic mass encountered. In the 262 patients examined 178 finally came to surgery, and of these ultrasound suggested the correct diagnosis in 78 patients and was helpful in a further 63 patients, a total of 141 (79 per cent). It is considered that these results would support our contention that ultrasound should be the first method of investigation in cases with a suspected pelvic mass other than those thought to be of intestinal origin.

The diagnosis of blighted ovum by sonar.

The outcome of 141 cases of bleeding in the first trimester of pregnancy has been correlated wit the findings obtained at the first and subsequent ultrasonic examinations. In 66 patients who aborted the ultrasonic appearances suggested a diagnosis of blighted ovum in 57. In 10 of the 75 patients in whom pregnancy continued the ultrasonic appearance was abnormal on at least one occasion.

CHANGES IN METACARPAL MINERAL CONTENT AND DENSITY IN NORMAL MALE AND FEMALE SUBJECTS WITH AGE

Using their own previously described technique, the authors measured the bone mineral from the third metacarpal of 312 male and 317 female volunteers. Two measurements were used. Firstly, the Standardised Aluminium Equivalent (S.A.E.) is a measurement of the amount of mineral in the path of the X-ray beam divided by the external diameter of the bone — thus allowing for variations in size of the subjects. Secondly, the density (λ) is quantitated. This is the amount of mineral per unit volume of cortical bone. The S.A.E. rises rapidly with age in both sexes to reach a peak at 36 years in male and 34 years in females. Thereafter the S.A.E. falls in both sexes especially in women after the age of 50 years, and the greatest fall is found within ten years of the menopause. The density (λ) rises rapidly in both sexes up to about 25 years of age. Thereafter a slow but steady rise occurs in men up to the age of 75. In women λ continues to rise up to the age of 40 and gradually falls after then. The external diameter of the third metacarpal increases rapidly in both sexes between the ages of 5 and 30, but does not significantly change thereafter.

Ultrasound in the diagnosis of fluid collections following renal transplantation

Ultrasound examinations of the pelvis and kidney have been carried out following 68 renal transplants. In 16 patients moderate sized or large perirenal or pelvic fluid collections were demonstrated. The composition of the fluid was lymph in seven cases, pus in four, blood in three and urine in two. Ten of these 16 patients had clinical features compatible with a pelvic fulid collection while six had no such localising features. We have found ultrasound to be extremely valuable in the diagnosis and precise localisation of pelvic fulid collections following transplantation, often at a stage before pressure effects and symptoms have appeared. It also provides a rapid and reliable means of excluding a pelvic or perirenal abscess in the pyrexial patient.

Ultrasound equipment for intra-rectal imaging of the prostate

Ultrasonic radial rectal scanning has been shown by workers in Japan (Watanabe 1971) and the USA (King et al., 1973; Resnick et al., 1976) to allow the identification of malignant change in the prostate with a high degree of accuracy. The apparatus used by Watanabe (1971), has become commercially available as the Aloka ASU–8M–C radial scanning chair. The apparatus facilitates the insertion of a transducer covered by a water bag into the rectum. The transducer is rotated by a motor drive and a radial scan of the pelvis is obtained. Preliminary work in our department was carried out using the above chair connected to an Aloka SSD–60C B scanner. These items were kindly loaned by LKB Instruments Ltd. Unfortunately this arrangement gave bistable pictures which were not felt to be of sufficient diagnostic value.